🩺 Head Tilt in Cats – Vet Guide 2025

By Dr Duncan Houston BVSc – Ask A Vet Blog Writer

1. What Is Head Tilt & Why It Matters 🎯

A head tilt is when a cat holds its head tilted to one side persistently. It’s a sign of vestibular dysfunction—a balance problem that may stem from the inner ear, brainstem, or sometimes the brain itself. While an occasional tilt may not be urgent, persistent or progressive tilt requires veterinary care in 2025—it’s a clue that something in your cat’s nervous or ear system needs attention.

2. How the Vestibular System Works

The vestibular system—located in the inner ear—is responsible for sensing movement and maintaining balance. It sends signals to the brain and muscles to coordinate head position and posture. Dysfunction can occur

• Peripheral (ear-based): causes include infection, inflammation, polyps, or trauma.
• Central (brainstem/brain): often more serious—due to stroke, tumor, FIP, or toxins.

3. What Head Tilt Looks Like

Signs to observe:

• Noticeably tilted head (mild to severe)
• Stumbling, circling, and falling
• Nystagmus (eyes beating side to side or up/down)
• Nausea or drooling due to dizziness
• Reluctance to eat or drink from a flat bowl

4. Common Causes of Head Tilt

4.1 Otitis Media/Interna (Ear Infection)

Bacterial or fungal infections in the middle or inner ear are common in cats. They may follow untreated outer ear infections, cause pain, discharge, and impair balance.

4.2 Ear Polyps or Tumors

Growths in the ear canal or middle ear—including inflammatory polyps or tumors—can affect balance and cause discharge, head shaking, and tilt.

4.3 Idiopathic Vestibular Syndrome

In many older cats, a sudden head tilt arises without a known cause. Symptoms often improve within days to weeks with supportive care.

4.4 Neurological Causes

• Stroke or infarct: Sudden head tilt, circling, and fast onset signs.
• Brain tumor or granuloma: Mass in the brainstem or cerebellum causing persistent tilt.
• Feline infectious peritonitis (FIP): Immune-mediated of the central nervous system—may cause tilt alongside fever and other signs.
• Toxins or trauma: Exposure to toxins (e.g., metronidazole toxicity) or head injury.

5. When to Contact Your Vet Immediately 🚨

• Sudden onset of tilt, circling, falling
• Head tilt + other neurologic signs (weakness, seizures, altered mentation)
• No improvement within 24–48 hours
• Ear discharge, bleeding, wounds, or pain
• Symptoms after trauma or toxin exposure

6. Veterinary Diagnostic Evaluation

Your veterinarian will tailor their work-up based on findings, including:

• Physical & neurologic exam: Assess head posture, reflexes, gait.
• Ear exam & cytology: Use otoscope to spot infection or foreign bodies.
• Bloodwork: CBC, biochemistry, infectious disease tests.
• Imaging: CT or MRI scans of head and ear if central cause suspected.
• Cerebrospinal fluid (CSF) sampling: Helpful for infection or inflammation.
• Culture or biopsy: For tumors or fungal disease.

7. Treatment Based on Cause

7.1 Ear Infection / Polyps

• Topical and systemic antibiotics or antifungals
• Anti-inflammatory therapy (e.g., steroids) to reduce swelling
• Polyp removal or surgery if needed
• Pain relief and ear flushing

7.2 Idiopathic Vestibular Syndrome

• Supportive therapy—anti-nausea meds, fluids, appetite stimulants
• Most cats begin improving within days, recover in weeks.

7.3 Stroke or Brain Injury

• Hospitalization for stabilization—fluids, corticosteroids, supportive care
• Address underlying vascular risk (e.g., hypertension)

7.4 Tumors or FIP

• Surgery or radiation for accessible tumors
• Antivirals (e.g., GS-441524) for FIP-related neurologic disease
• Comfort care, corticosteroids, anti-inflammatory medications

7.5 Toxin or Trauma

• Hospitalization for detoxification/fluids
• Medication for brain swelling
• Observation and supportive care

8. Home Care & Comfort Support

• Provide padded, non‑slip bedding and ramped access
• Elevate food/water to reduce neck strain
• Administer anti-nausea meds and pain management
• Encourage gentle movement to prevent stiffness
• Keep litter boxes low-sided and easy to access
• Monitor eating, drinking, and elimination closely

9. Monitoring Progress

• Record tilt angle, circling, ability to eat/drink daily
• Photos/videos help vets track improvement
• Follow-up visits for rechecks and possible imaging

10. The Role of Ask A Vet, Woopf & Purrz 🛠️

• Ask A Vet: Share videos of tilt or nystagmus, ask about administering meds or managing nausea remotely.
• Woopf: Produces non-slip flooring pads and comfortable elevated bowl stands perfect for balance‑impaired cats.
• Purrz: Offers neurologically supportive supplements and calm-care bedding designed for comfort during recovery.

11. Prognosis & Outlook

• Ear infections/polyps: Often fully resolve with treatment—tilt usually reverses.
• Idiopathic vestibular syndrome: Good recovery—tilt improves over 1–3 weeks.
• Stroke or FIP: Recovery varies—some cats improve substantially with support.
• Brain tumors: Prognosis depends on type, location, treatment options.
• Many cats regain healthy balance and quality of life.

12. Key Takeaways ✅

• Persistent or sudden head tilt is a medical red flag.
• Often ear-based, but neurological or systemic causes possible.
• Diagnosis may include ear exam, imaging, bloodwork.
• Treatment depends on cause and may include meds, surgery, or antivirals.
• Home support and monitoring are vital.
• Brands Ask A Vet, Woopf & Purrz enhance recovery and comfort.

13. Final Thoughts ❤️

A tilted head in your cat says, “I need help.” Don’t ignore it—timely veterinary attention often leads to a smooth recovery. With accurate diagnosis, tailored treatment, and caring home adaptations, most cats regain balance and happiness. Concerned? Reach out via Ask A Vet or visit your vet today. Your loving care makes all the difference.